ICD -10 TRANSITION AS IT RELATES TO VISION

Presented by: MARCH Vision Care, 2013

INTRODUCTION

• During the summer of 2008, the Department of Health and Human Services (HHS) initiated the implementation process of International Classification of Diseases, 10th Edition (“ICD-10”).

• Providers, health plans and clearinghouses are all required to adhere to the updated code-set regulations as set forth by HHS upon the date of implementation.

• The transition to ICD-10 is due to ICD-9 data limitations regarding patient medical conditions, and hospital inpatient procedures. The ICD-9 system is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 restricts the ability to add new codes, and many ICD-9 categories are full.

SCOPE

ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:

1. ICD-10-CM: Used to identify diagnosis codes in all healthcare settings.

2. ICD-10-PCS: Used for facility reporting of hospital inpatient services.

• Diagnosis Code Set = Clinical Modifications (ICD-10-CM) • Inpatient Procedure Code Set = Procedure Coding System (ICD-10-PCS)

WHO NEEDS TO TRANSITION ?

ANSWER:

• ICD-10 affects diagnosis and inpatient procedure coding for all groups covered by the Health Insurance Portability Accountability Act (“HIPAA”), not just those who submit Medicare and/or Medicaid claims. The change to ICD-10 does not affect Current Procedural Terminology (“CPT”) coding for outpatient procedures.

• Health care providers, payers, clearinghouses and billing services must be prepared to comply with the transition to ICD-10.

• Claims with ICD-9 codes for services provided on or after the compliance deadline cannot be paid.

ICD-9 TO ICD-10: HIGH LEVEL OVERVIEW

ICD-9 vs. ICD-10 SAMPLE OF NEW CODING

ICD-9-CM ICD-10-CM

367.2 Astigmatism H52.2 Astigmatism

367.20 Unspecified Astigmatism H52.20 Unspecified Astigmatism H52.201 – unspecified eye H52.202 – right eye H52.203 – left eye H52.204 – bilateral

367.21 Regular Astigmatism H52.22 Regular Astigmatism H52.221 – unspecified eye H52.222 – right eye H52.223 – left eye H52.229 – bilateral

367.22 Irregular Astigmatism H52.21 Irregular Astigmatism H52.211 – unspecified eye H52.212 – right eye H52.213 – left eye H52.219 – bilateral

WHAT’S WRONG WITH ICD-9?

• ICD-9 is outdated; implemented in 1979.

• ICD-9 code structure is running out of space and cannot support the addition of new codes to address new medical technology or diseases.

• The eHealth initiative and benefits from electronic health record (“EHR”) systems cannot be achieved without replacing ICD-9.

• ICD-9 codes do not capture data relating to factors other than disease which significantly limits research capabilities.

• Over 100 other nations have already replaced ICD-9; hindering international comparisons of data, leading to pressure from the World Health Organization on the United States to transition.

A NEW WAY TO THINK ABOUT THE TRANSITION

• ICD-9 = Coding

• ICD-10 = Information Collection

ICD-10 IMPACT ON PROVIDERS AND PAYERS

Physicians Clinical Administrative Staff Patient Accounting Coders IT Staff Coding/ Billing Workflows Contracting Approaches Prior Authorization/ Notification Changes Reporting Analytics Physician/ Coder Query Process Claims/ Billing Systems System Interfaces Electronic Data Interchanges (Clearinghouses) Practice Management Systems

PEOPLE – PROCESS – TECHNOLOGY –

ICD-10 RESOURCES

Providers are encouraged to take advantage of the tools available to assist in preparing your practice.

• www.cms.gov/ICD10

• www.himss.org

– Click on the Resource Library Tab – Go to “Health IT Topics” – Click on the “ICD-9 to ICD-10 Conversion” link

• www.unitedhealthcareonline.com

– Go to “Quick Links” – Click on the “HIPAA 5010 and ICD-10” link

• MARCH provider newsletters and bulletins

FAQ’S

• What is the effective date of the transition?

ANSWER: October 1, 2015.

• What does “ICD-10 compliance” mean?

ANSWER: ICD-10 compliance means that all groups/individuals covered by HIPAA are able to successfully conduct health care transactions using ICD-10 codes.

• Will ICD-10 replace Current Procedural Terminology (CPT) procedure coding?

ANSWER: NO, the switch to ICD-10 does not affect CPT coding for outpatient procedures. Like ICD-9 procedure codes, ICD-10-PCS codes are for hospital inpatient procedures only.

FAQ’S

• Can I bill with ICD-9 and ICD-10 codes on the same claim after 10/1/2015?

ANSWER: No, claims must be submitted separately. You cannot have both ICD-9 and ICD-10 on the same claim.

• Who is affected by the transition to ICD-10? If I don’t deal Medicare claims, will I have to transition?

ANSWER: All groups/individuals covered by HIPAA must transition to ICD-10. This includes providers and payers who do not deal with Medicare claims.

• Do state Medicaid programs need to transition to ICD-10?

ANSWER: Yes, all groups/individuals covered by HIPAA must comply with ICD-10 requirements; this includes all state Medicaid programs.

• What happens if I don’t switch to ICD-10?

ANSWER: Claims for all services and hospital inpatient procedures performed on or after the compliance deadline must use ICD-10 diagnosis and inpatient procedures codes. Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed.

FAQ’S

QUESTIONS?